Understanding Breast Cancer-Related Lymphedema

If you’re navigating the journey of breast cancer recovery, you may be facing the challenge of breast cancer-related lymphedema. This condition occurs when lymph fluid builds up in the tissues under the skin. Understanding lymphedema, its causes, symptoms and management is crucial in regaining control and comfort in your daily life.

As a physical therapist with Franciscan Health, Grace Kim, PT, CLT, provides expert insights into breast cancer-related lymphedema.

What Is Breast Cancer-Related Lymphedema?

Breast cancer-related lymphedema is a condition that can occur after breast cancer surgery, such as lumpectomy or mastectomy.

“Removing lymph nodes during these procedures can change the lymphatic system’s structure, potentially leading to fluid build-up and swelling in the affected areas,” said Kim. “This occurs because the remaining lymph vessels cannot adequately drain.”

Risk Factors For Developing Lymphedema After Breast Cancer Treatment

Knowing the risk factors for developing lymphedema after breast cancer treatment is key to prevention and early detection. Some risk factors include:

• Lymph node removal: The extent of lymph node removal during surgery directly impacts the risk of developing lymphedema. Approximately 5-17% of individuals who undergo sentinel lymph node biopsies develop lymphedema. This percentage increases significantly to 20-53% for those with more extensive axillary lymph node dissection.
• Radiation treatments: These can lead to scar tissue formation that affects the lymphatic system. It can compress or narrow the remaining lymph vessels and nodes.
• Excess weight: Carrying extra weight might pressure lymph nodes and affect lymph flow.
• Infection: This can trigger lymphedema or aggravate an existing condition.

Lymphedema Warning Signs And Symptoms

As a breast cancer survivor, it’s important to be on the lookout for initial symptoms that may signal the beginning of lymphedema. Key signs to watch for include:

• Changes in skin texture, tightness, redness or hardness
• Decreased flexibility in the shoulder, elbow, wrist or hand
• Difficulty fitting an arm into clothing
• Swelling in the breast, chest, shoulder, arm or hand
• Tightness in rings, watches or bracelets

Preventing Lymphedema In Breast Cancer Survivors

Preventing lymphedema after breast cancer treatment involves a combination of regular health monitoring and lifestyle adjustments, Kim said.

“Taking proactive steps can significantly reduce your risk of developing lymphedema,” she said.

Here are a few preventive steps breast cancer survivors can take:

• Maintain a healthy weight and diet.
• Get regular medical check-ups, including lymphedema screening.
• Utilize SOZO for lymphedema screening, a device used by Franciscan Health. SOZO uses bioimpedance, which refers to the process of sending a painless electrical current through the body. Measuring the body’s resistance in response to the electrical current provides detailed information regarding fluid and tissue status. 

The Role Of Exercise In Managing And Reducing Lymphedema Risk

It’s important to use your affected arm, Kim said.

“Using your muscles helps drain lymph fluid from your arms,” she said. “It also helps keep your muscles flexible and helps reduce scarring.”

Exercise regularly, but try not to over-tire your shoulder and arm. 

The Benefits Of Compression Garments In Lymphedema Management

Compression garments can significantly help control hand and arm lymphedema by helping to move lymph fluid back into the body. Compression garments help reduce swelling.

“If chest or breast swelling occurs, a specialized compression bra or vest can also help reduce swelling,” Kim said.

Self-Care Techniques And Daily Routines To Minimize Lymphedema

“Manual lymph drainage (MLD) is a very effective daily routine to enhance lymphatic circulation in the affected arm,” Kim said.

This massage helps reduce fluid volume and can be taught by a lymphedema specialist or therapist.

Treatments For Severe Lymphedema

One of the most effective ways to treat lymphedema is with lymphedema therapy or complete decongestive therapy, Kim said. This method combines compression (often using layered bandaging), manual lymph drainage (a specialized massage to move lymph fluid), exercise and skin care.

Post-therapy, it is usually necessary for individuals with lymphedema to continually wear compression on the affected arm to help reduce swelling. Even in severe cases, lymphedema therapy can lead to significant improvements.

Surgical options also help reduce, but not cure, lymphedema. These include:

• Lymph node transfer – transferring a lymph node to the lymphedema-affected area.
• Lymphovenous bypass – connecting lymphatic vessels to venous vessels to help manage lymph fluid. These techniques generally help with mild to moderate cases rather than severe chronic lymphedema.

For severe chronic cases, a procedure called debulking may be used. This involves the surgical removal of hardened fibrotic tissue. After the surgery, compression garments are often still necessary to help control swelling.

Personal Stories From Breast Cancer Survivors

Kim said she has had many patients share inspiring stories of coping with lymphedema after breast cancer treatment.

“One involves a woman who struggled with chronic arm lymphedema for over a decade,” she said. “She couldn’t receive lymphedema therapy immediately due to being busy with work and family issues.”

Over time, her lymphedema worsened and became severe.

“We started traditional lymphedema therapy, including manual lymph drainage, compression therapy and therapeutic exercises,” Kim said. “After a few months, her arm became smaller, and she could use it for her daily activities as before. It’s really rewarding to help people who had limited activities because of swelling and see them use their arms better.”

Resources And Support Groups

Breast cancer survivors dealing with lymphedema can find support and resources through organizations like the National Lymphedema Network. This network can help you find support groups in your area. Contact them by calling 1-800-541-3259 or visiting lymphnet.org for more information.

The American Cancer Society Cancer Survivors Network is a free online community created by and for people with cancer and their families. You can visit csn.cancer.org to get support and connect with others. When you develop lymphedema, contact your primary doctor or oncologist to find a lymphedema specialist.